Direct Oral Anticoagulants versus Vitamin K Antagonists in Individuals Aged 80 Years and Older: An Overview in 2021

Chana Azzoug; Gilles Nuémi; Didier Menu; Emmanuel De Maistre; Mathieu Boulin; Alain Putot; Patrick Manckoundia

doi:10.3390/ijerph20021448

Direct Oral Anticoagulants versus Vitamin K Antagonists in Individuals Aged 80 Years and Older: An Overview in 2021

Int J Environ Res Public Health. 2023 Jan 13;20(2):1448. doi: 10.3390/ijerph20021448.

Authors

Chana Azzoug¹, Gilles Nuémi², Didier Menu³, Emmanuel De Maistre⁴, Mathieu Boulin⁵, Alain Putot^{6

7}, Patrick Manckoundia^{1

8}

Affiliations

¹ "Pôle Personnes Âgées", Hospital of Champmaillot, University Hospital, 21079 Dijon, France.
² Medical Information Department, University Hospital, 21079 Dijon, France.
³ "Mutualité Sociale Agricole" of Burgundy Franche Comté, 21000 Dijon, France.
⁴ Haemostasis Unit, University Hospital, 21079 Dijon, France.
⁵ Pharmacy Department, University Hospital, 21079 Dijon, France.
⁶ Department of Internal Medicine and Infectious Diseases, Pays du Mont Blanc Hospital, 74700 Sallanches, France.
⁷ Physiopathologie et Épidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, University of Burgundy, 21000 Dijon, France.
⁸ INSERM U-1093, Cognition, Action and Sensorimotor Plasticity, University of Burgundy, 21000 Dijon, France.

Abstract

Two main types of oral anticoagulants are available in France: vitamin K antagonists (VKA) and, more recently, direct oral anticoagulants (DOAC). The benefit−risk profile appears to be favorable for DOAC, which is as effective as VKA but safer (fewer cases of severe and cerebral bleeding). In a study in 2017, we observed that older adults did not seem to receive the same modalities of oral anticoagulants as younger individuals for various reasons. To assess anticoagulation prescribing practices over time, we repeated this cross-sectional study by comparing very old individuals taking DOAC to those taking VKA. Ambulatory individuals aged 80 years and older were included. They were affiliated with the Mutualité Sociale Agricole of Burgundy and were refunded for a medical prescription of oral anticoagulation in March 2021. The demographic characteristics, registered chronic diseases (RCD), number and types of prescribed drugs, and mortality of the DOAC group and the VKA group were compared. A total of 4275 subjects were included in the study: 67.44% (2883) received DOAC and 32.56% (1392) received VKA. The two groups were similar in age. In the DOAC group, there were more women (54.98% vs. 46.98%) (p < 0.001), fewer RCD (91.47% vs. 93.68%) (p = 0.014), and lower rates of venous thromboembolism (2.53% vs. 6.75%) (p < 0.001), severe heart failure (56.50% vs. 68.03%) (p < 0.001), and severe kidney diseases (1.38% vs. 3.59%) (p < 0.001), but there were more subjects with Alzheimer’s disease (7.49% vs. 4.31%) (p = 0.001). Individuals in the DOAC group had fewer prescriptions of furosemide (48.53% vs. 55.75%) (p < 0.001) and fibrates (2.32% vs. 3.88%) (p = 0.044). They also had more prescriptions of proton pump inhibitors (43.95% vs. 39.44%) (p = 0.006) and antirheumatics (1.60% vs. 0.65%) (p = 0.009) than those in the VKA group. There was no difference in mortality. This study revealed that prescribing practices for DOAC have changed over time.

Keywords: aged 80 and over; anticoagulant; direct oral anticoagulants; vitamin K antagonists.

MeSH terms

Administration, Oral
Aged
Anticoagulants* / therapeutic use
Cross-Sectional Studies
Female
Fibrinolytic Agents
Hemorrhage*
Humans
Vitamin K

Substances

Anticoagulants
Fibrinolytic Agents
Vitamin K

Grants and funding

This research received no external funding.